INVOLVING STAKEHOLDERS IN IMPROVING QUALITY OF HIV CARE Dan Sendzik, HIVQUAL Consultant Phone: 71894

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INVOLVING STAKEHOLDERSIN IMPROVING QUALITY OF
HIV CAREDan Sendzik, HIVQUAL ConsultantPhone
718-940-5934Email DPS9001_at_nyp.orgstakeholders05
2806
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Whats on the agenda?

• Questions
• Stakeholders Themes from Literature
• Who Matters? (An Exercise)
• One Stakeholders Perspective
• By the Book
• A Case Study
• Applying What Weve Discovered
• Bringing It Home One Resolution

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Introductions

• Your Name and Institution
• What was your first job?
• Whats the most important thing you learned from
  it?

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Questions (including Yours)

• What is buy-in?
• Why is it important to a QI program?
• What do we mean by stakeholders? (Who has a
  stake? Who cares? Whos affected?)
• How do you engage stakeholders?

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Stakeholder Involvement Themes from the
Literature   www.isixsigma.com Definition St
akeholder Anyone who is affected by or can
influence a project.   Alternative
definitions People who are, or might be,
affected by any action taken by an organization.
Examples customers, owners, employees,
associates, partners, contractors, suppliers,
related people or those located nearby.
 

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www.ihi.org  

• Themes from the Literature (Continued)
• www.ihi.org
• Quality is not a department.
• An organization will only make meaningful and
  sustainable quality improvements when people at
  every level feel a shared desire to make
  processes and outcomes better every day, in bold
  and even imperceptible ways.
• Identify the Adopter Audiences
• There are different audiences within the group.
  Those that are key to the process being improved
  must make the decision to adopt the improvements.
• Develop and Use Key Messengers
• Key messengers are those who advocate for the
  improvement to be spread. Key messengers play an
  integral part in the communication campaign by
  building awareness and providing information
  about the improvements to others
• Spreading Change
• Involves leadership, strategy, making the case
  for a better idea, communication, understanding
  the social system, managing best practices, and
  measurement and feedback.
• .
• .
•  
•  

 
 
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• Themes from the Literature (continued)
• www.iqa.org
• Culture Club
•  
• By classifying stakeholders into groups (such as
  employees, customers, community, partners,
  government and regulators), their needs can be
  more clearly identified and their relationships
  with the organization more effectively managed.

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• Themes from the Literature (continued)
• Management Approach
• Managing Change for Results Work-Out
  Facilitation Skills Workshop
• Emphasizes that effective change
• Depends on Quality x Acceptance
• Acceptance Stakeholder involvement, buy-in
• Requires changing the way quality program is run,
  from top-down (directing) to multidirectional
  (guiding, vision, empowering groups and
  individuals)
• -GE Medical Systems, Managing Change for Results

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Themes from the Literature (continued) Other
Abstracts from the IHI website (www.ihi.org)   C
onsumer Involvement When Leaders Embrace
Change Patient-Centered Care Advancing Patient
Centered Care to the Next Level Leadership
Ensure the Topic to Be Spread is a Key Strategic
Initiative of the Organization Patients as
Partners How to Involve Patients and
Families in Their Own Care
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Who Matters?

• (An exercise)

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Six Roles That People Play in Any
Community/Ongoing Group Dr. Jorga Leap,
UCLA     Hub Communication central, knows what
goes on   Pillar Been around for a long time, a
fixture in the institution   Gatekeeper Controls
access, can facilitate or block things from
happening Pulse taker Observer, knows how others
are feeling, what theyre thinking   Formal
leader Person with the title (Director,
Administrator, Chief)   Informal leader May/may
not have title, but can inspire others
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The New Nurse   After 10 years of service, the
head nurse in your clinic has moved to the West
Coast because her husband has been transferred.
The new head Nurse, Ms. Champion, started work
today. She has worked for the past 8 years in an
HIV clinic in the West Village of Manhattan,
primarily serving gay men. Your clinic is much
more diversehalf the patients are female, most
are people of color, many are recent immigrants.
The staff, likewise, is very diverse.   Of the
six roles we discussed, which are you
usually? Formal leader Gatekeeper Hub
Informal leader Pillar Pulse
taker What things can you do, in your role, to
help Ms. Champion get off to a good start and be
successful in her new position?   What things
could you do that would make things more
difficult for her? -------------------------------
--------------------------------------------------
------------------------------------------------
Now, draw a new role for yourself.   In this
role, what things could you do to help things go
well for Ms. Champion?   What would motivate you
to do your best to help her?
 
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The Surprise Visitor   While working in your
clinic one morning, you are told at 900 AM that
a surveyor from JCAHO (the Joint Commission) has
made a surprise visit to your facility. It is
likely that the surveyor, Dr. Matthews, will come
to your clinic later in the day.   Your clinic
administrator calls a staff meeting for 1200
Noon to make sure things are ship-shape, should
Mr. Matthews come to your area.   Of the six
roles we discussed, which are you usually? Formal
leader Gatekeeper Hub Informal
leader Pillar Pulse taker In your
role, what things can you do throughout the rest
of the morning, during the staff meeting, and
during Dr. Matthews visit, to ensure that it
will go well?   What things might you do that
would cause things to go badly? ------------------
--------------------------------------------------
--------------------------------------------------
---------------- Now, draw a new role for
yourself.   In this role, what things could you
do to ensure that the survey will go well?   What
would motivate you to do your best?

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BREAK TIME!
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One Stakeholders Perspective   Kenneth, a man
with many hats.   What will motivate someone
to work for quality-of-care in an HIV programif
they are a         Consumer?         Staff
person?         Family member?        
Community member?         CBO staff
member?         Advisory Board Member?        
PI Committee Member?
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Methodology(brainstorm)

• What are key actions in achieving buy-in?
• ___________________________
• ___________________________
• ___________________________
• ___________________________
• ___________________________

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Methodology(ideas from the Group Learning Guide)

• Convey importance of QI to external agents
• Organize educational activities to promote
  quality
• Recognize staff for QI efforts
• Institutionalize improvements
• Demonstrate program successes
• Commit resources

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Case Study

• (see handouts)

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• CASE STUDY THE MAIN STREET HEALTH CENTER
• Background
•  
• The Main Street Center is a mid-sized Section 330
  grant-funded community health center located in a
  busy urban area. The center offers a wide variety
  of primary care and specialty services.
•  
• The infectious Diseases Clinic has daily sessions
  for HIV patients and has 11 staff members
• Medical Director (Ellen Fazio, MD)
• Administrator, also a nurse by training (Jen
  Smith RN)
• Clerk who handles scheduling and patient
  registration (Sandy Cutler)
• 3 case managers
• 3 physicians
• 2 nurses
• Irene Ma, MD, is the centers medical director,
  while Ed Curtis serves as its administrator.

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CASE STUDY THE MAIN STREET HEALTH CENTER
(CONTINUED) History of Quality Improvement
Program   The Main Street Health Center has an
existing Quality Management Program to which the
Infectious Diseases Clinic occasionally submits
statistics. Ellen Fazio, Medical Director of the
Infectious Diseases Unit, started a separate HIV
quality program two years ago, but the program
has been only tangentially involved with the
facilitys Quality Management Programonce the
statistics are submitted, there is no additional
contact.   Recently, the HIV quality program
decided to participate in the HIVQUAL project and
collected performance data for 2005. Dr. Fazio,
the Medical Director, is very excited about the
data but hasnt been able to get anybody else to
take notice, including the centers leadership
(Medical Director Irene Ma and Administrator Ed
Curtis), as well as the other clinical staff in
the HIV program.
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List concrete tasks which would help the Main
Street Health Center achieve each of the 6
strategic aims.  

• List concrete tasks which would help the Main
  Street Health Center achieve each of the 6
  strategic aims.
• Convey the importance of QI to external agents
• _________________________________________________
  
• ________________________________________________
• Organize educational activities to promote
  quality
• _________________________________________________
  
• _________________________________________________
• Recognize staff for their QI efforts
• _________________________________________________
  
• _________________________________________________
  
• Institutionalize quality improvements
• _________________________________________________
  
• ________________________________________________

•  

 

•  

 
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How does this apply to my program?(Pair
one-to-one,using Learning Transfer Worksheet)
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LEARNING TRANSFER WORKSHEET  Assess your actions
in establishing support for your HIV program.
Using the information from todays session,
complete the grid below and briefly describe your
programs strengths and weaknesses.  
 
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One thing I will do on Monday to increase
stakeholder involvement in my HIV QI
program________________________ Write it
down.Put it in your pocket.Promise yourself
Ill do it on Monday.
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Wrap-Up
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